By: Daniel DiGiacomo, MD, MPH, FAAP
Pediatricians often watch for signs of one illness that might signal another could be on the way. One example of linked health issues is the
allergic march, a pattern that affects millions of babies and children worldwide.
If you're wondering about the allergic march and its possible impact on your child's health, read on for helpful insights.
What is the allergic march?
The allergic march (also called the atopic march) is a chain of health problems that typically happen one after the other. All may have common roots in the immune system.
Which conditions can be part of this pattern?
The first sign is usually
atopic dermatitis (AD), a form of eczema that often appears before a child's first birthday. AD causes dry, itchy, scaly patches on a baby's skin that may signal increased risks for:
For some children, another condition called
eosinophilic esophagitis (EoE) can appear later in the allergic march. EoE is an allergic inflammation of the esophagus—the tube that carries food from the mouth to the stomach. It can make swallowing difficult and cause symptoms like vomiting or abdominal pain.
Does the atopic march always follow the same course?
Ongoing studies show that the allergic march can unfold in different ways. For example, it might begin with
food allergies instead of AD. More than one condition might emerge at the same time, instead of one following the other(s). Some little ones will have AD and allergies but never progress to asthma, which shows that the allergic march will not happen for everyone. However, studies confirm that
1 of every 3 babies and toddlers who have AD will develop allergies or asthma later on, usually before they turn 5.
What causes the allergic march?
Research suggests that the allergic march begins in the
immune system, which defends a child's body against infections that can make them sick.
Kids with allergic-march conditions may have sensitive immune systems that fight hard when they're exposed to certain triggers (allergens). These triggers don't usually sicken other kids, but they can cause dangerous, even
life-threatening reactions in children with allergies or asthma.
Allergens that can cause flare-ups in young children include:
Foods made with eggs, peanuts, cow's milk, fish, soybeans, tree nuts, wheat or sesame
Irritants they breathe in, such as tobacco smoke, pollution, pollen or dust
Things that bother their skin, such as pet dander, laundry soaps, fragrances and more
Do some children face even higher risks for allergies and asthma?
Though there's strong scientific proof that allergies and asthma run in families, genes may not be the only cause. Studies have linked childhood obesity—especially before age 2—with elevated asthma risks. In addition, a less diverse diet in pregnant mothers is linked to food allergy and asthma risk.
Kids with heavy exposure to polluted air, tobacco smoke, animal dander and other irritants may develop allergies at higher rates than others. Black, Hispanic and Indigenous children are more vulnerable to asthma than white children, which might reflect high levels of allergens where some families live or difficulties in getting effective care. If you're worried about your child's risks, talk with your pediatrician about protective strategies.
Are there ways to stop the allergic march?
There is no single treatment that stops the allergic march in its tracks. But there are ways to slow its progress. Sharing
your family health history with your child's doctor is a helpful first step. Risks for eczema, allergies and asthma tend to run in families, so it's wise to discuss possible risks with your pediatrician.
Prevention can begin even before babies are born. Eating a balanced, nutrient-rich diet and avoiding antibiotics or antacids while you're expecting can strengthen your infant's immune system. Research shows that vaginal deliveries—whenever safe and possible—may contribute to healthy immunity too.
After your baby arrives, preventive steps include:
Protecting the skin barrier. Some researchers believe that dry, cracked skin gives allergy triggers an easy route into a child's body, literally setting the stage for allergic conditions. For those babies who have eczema, it is important to ensure the skin barrier is healthy by moisturizing your child's skin with an emollient-rich cream. Using anti-inflammatory treatments (like topical steroids) when recommended by your pediatrician also can help. Babies and toddlers with eczema, especially AD, may need specialized care to prevent flare-ups.
Early exposure to some foods. Feeding your baby small amounts of
peanuts, eggs and other common food allergens can teach their body to tolerate them. Talk with your pediatrician about foods to test out, what to watch for and when to seek care for an allergic reaction.
Effective allergy care. If your child develops allergic rhinitis, consistent care may reduce the chances that asthma will follow. Your pediatrician can help you
pinpoint allergy triggers and minimize their impact at home, school, day care and in other spaces. Allergen avoidance measures, allergy medicines and breathing treatments may be part of your child's care plan.
Immunotherapy. These are allergy shots that work with the immune system to make your child less vulnerable to flare-ups. Increasing doses of the allergy trigger(s) that make them sick helps the body learn to tolerate them, which may slow the allergic march, especially the start of asthma.
Remember
Talk with your child's doctor if you see signs of illness that could be linked with the allergic march. Diagnostic tests can help confirm what's happening so you and your pediatrician can create an effective wellness plan for your child. Diagnosing and treating allergic-march conditions can help kids lead active, healthy lives.
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About Dr. DiGiacomo
 Daniel DiGiacomo, MD, MPH, FAAP, is a pediatric allergist/immunologist at K. Hovnanian Children's Hospital at Jersey Shore University Medical Center. He completed his pediatrics residency at Children's National Medical Center and fellowship training at Massachusetts General Hospital in Boston. Dr. DiGiacomo, a member of the American Academy of Pediatrics (AAP) Sections on Allergy and Immunology and Epidemiology, Public Health and Evidence, has a clinical interest in infant food allergy. He enjoys spending time at the beach with his family during his time off, and is an avid New York sports fan.
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